Trumpcare

Trumpcare 2.0 Is Already Falling Apart

Vice President Mike Pence is leading the White House effort to revive the zombie House health-care legislation.

By Shawn Thew/EPA/Rex/Shutterstock.

Zombie Trumpcare is dying, again. Less than 48 hours after the White House reopened talks to revive the failed G.O.P. health-care bill, the negotiations have reportedly already broken down over fundamental disagreements within the party.

The last-ditch push to secure a legislative victory before Congress departs for a two-week recess quickly devolved on Tuesday as conservative hardliners and centrist Republicans in the House clashed over the White House’s muddled vision to bring the troubled legislation back from the dead. Earlier this week, Vice President Mike Pence, Chief of Staff Reince Priebus and budget director Mick Mulvaney offered what they hoped would be a palatable compromise: allowing states to individually opt out of a number of popular Obamacare insurance regulations. But nobody seems to agree on what, precisely, the White House is selling. And the gap between how conservatives and moderates are interpreting Trump’s proposal is wide enough to drive a stake through.

Among the regulations that could become optional is the “community rating” provision, which bars insurance providers from charging people more based on their health, age, or gender. Mark Meadows, the chairman of the arch-conservative Freedom Caucus, reportedly said that his faction was told states would be granted the option to reject “all community ratings with the exception of gender.” He also suggested that he was told the “guarantee issue,” which prevents insurers from refusing coverage for individuals with pre-existing conditions, was also on the table. According Meadows, the new compromise would shunt these individuals into state-run risk pools, that would be subsidized through a $115 billion “stability fund.”

But for moderates this is a non-starter. Multiple sources told Politico that Energy and Commerce chairman Greg Walden, a key player in the moderate Tuesday Group, interpreted the proposed repeal of the community rating as only applying to age and began drafting legislation reflective of that. Centrists view the community rating and guarantee provisions as hand in glove with the G.O.P. promise to retain Obamacare protections for individuals with pre-existing conditions.

Critics argue that if the more conservative proposal were to pass, insurance providers could effectively price individuals out of the market based on their age or health, even if they technically offered them coverage. The Freedom Caucus vigorously disputes this interpretation. “We've never ever wanted to go after pre-existing conditions,” one caucus member told Axios. “That's spin (well a lie) meant to undermine us. Pence said he supports our plan of reforming, and funding changes to high risk pools, specifically to deal with pre-existing conditions.”

The growing gulf between House conservatives and moderates is far from the only obstacle facing Obamacare repeal as the White House pushes to put a legislative win on the scoreboard ahead of the president’s 100th day in office. Politico reports that White House officials have privately expressed doubts that House Republicans are capable of forming a consensus in the near future. In fact, the current deal is reportedly bleeding potential votes—not gaining them. A number of hardliners are still unconvinced that the bill goes far enough in repealing Obamacare. “I don’t know of a single Republican that got elected promising to be generous with waivers from our all-powerful position,” said Rep. Louie Gohmert. “I want to get to where we promised.” Moderates, meanwhile, are opposed to any compromise that they see as a concession to the far-right. “I have seen nothing in terms of reported possible changes to American Health Care Act warranting reconsideration. I remain a NO,” Rep. Frank LoBiondo, a member of the Tuesday Group, tweeted. Charlie Dent, a vocal critic of the A.H.C.A., echoed the sentiment. “My position remains the same,” he said. “I’m still opposed to the bill in its current form, even with the changes I’ve heard suggested.”

Public opinion, too, is turning against the Obamacare repeal effort. A new Gallup poll found that the majority of Americans approve of the Affordable Care Act for the first time. According to the poll, 55 percent of people generally support the legislation, up from 42 percent five months ago. Conversely, 64 percent of the American public say it’s a “good thing” that Trumpcare failed to pass at the end of last month, with public opinion shifting toward improving the Affordable Care Act, not repealing it, according to a Kaiser Health tracking poll.

Republicans seem to see the writing on the wall. One White House official told Politico “everyone is cautious.” Others are reportedly reluctant to pin down a timeline for Trumpcare 2.0. “I don’t know that we should be putting an arbitrary timeline on it, because that’s the kind of thing that gets you in trouble,” Rep. Morgan Griffith said.